Changing Behavior... & Teaching New Skills

Naomi Swiezy, Ph.D.
Disability Solutions
September/October 1999, Volume 3, Issue 5 & 6, p. 25-30
  Printed with the permission of Joan E. Medlen, R.D., Editor
© 1999 Creating Solutions
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Taking your child to a clinic for an evaluation is an intimidating process. Often a variety of diagnoses or labels are discussed and considered, confusing the big picture you have of your child. You leave with one question: "Now what do I do about it?" This article will address this issue by presenting practical tips for managing your child's inappropriate behaviors while also teaching some appropriate behaviors and alternative skills.

Parents of children with Down syndrome and autistic spectrum disorder (DS-ASD) are especially in need of these tips because there is so little information available about this dual diagnosis for parents or professionals. As parents, you become comfortable accommodating your child's learning style based on information about Down syndrome and your own experiences. Then the latter diagnosis, autistic spectrum disorder, is superimposed on the first. At this point many parents are overwhelmed. They feel as though all hope for modification is lost. However, if you approach your child's behavioral difficulties that are often associated with autistic spectrum from a systematic, behavioral perspective, you will feel renewed hope for not only behavioral management, but also for skill development.

One methodology that has proven effective for children with autistic spectrum disorders, including those with Down syndrome, is applied behavioral analysis or ABA approaches. ABA approaches are based on the idea that we know when children misbehave, they often have some motivation to do so. We also know children learn from their environments and adapt their behavior to gain access to what motivates them the most. What becomes confusing is that each child is motivated by different factors and sometimes more than one factor at a time. To address this, ABA uses systematic and empirical ways to assess the individual motivational factors of each child. With this information, individual programs or plans are created addressing both what happens before the behavior as well as the consequences for the behavior itself.

There are several general guidelines you can use to improve behavior-related problems without conducting a formalized assessment. These strategies will improve your child's behavior regardless of the specific motivation behind them. However, we first need to look at some general facts about children with Down syndrome and autistic spectrum disorder (DS-ASD) that form the basis for working effectively with your child:

Helping Your Child Achieve Her Potential

The most effective approach to shaping appropriate behavior for children with DS-ASD is to create opportunities in the environment for the behavior you want to occur. It is equally important to respond to inappropriate behaviors with effective management strategies. Below are some general guidelines that address both of these angles. If you are overwhelmed or faced with behaviors that are very difficult or pervasive in nature, please consult a trained behavioral specialist who is familiar with ABA strategies. A trained ABA specialist will work with you and your family to build specific recommendations and plans for your child.

Environmental Controls

Use these ideas and methods to set the stage for your child's success and encourage appropriate behavior. It takes planning, but it is an important part of shaping your child's behavior. Once this is done, take a look at teaching your child what it is you would like them to do.

Using Prompts to Teach New Skills

Children with DS-ASD may do better using specific teaching methods for new tasks. Your child must understand the request, what action to take to follow the direction, and then do those things. To do this, your child may need a variety of cues (visual, verbal, and physical) for her to understand and then follow-through with action. In addition, her interest in repetitive or other behaviors may interfere with her ability to follow your direction. Teaching your child to follow simple commands is a basic tool for managing your child's behavior. If your child is not attentive or receptive to your demands then this will limit your child's ability to learn more adaptive ways of responding.

One way to present new directions and teach the requested response is called guided compliance procedures. This method is effective with gaining compliance in most cases. There are three basic steps to the procedure:

Verbal prompt:
Give your child a clear instruction and wait five seconds. If she follows your direction (complies), praise her in a manner that specifically and concisely details what she did well. (e.g., state "That's good for....." and insert the task completed). If she does not comply, move to the next step: a gestural and verbal prompt.
Gestural prompt:
Show your child the exact response you desire. As soon as you complete the task, return things, or yourself, so they are exactly the same as before you gave the prompt. Tell her, "now you do it." Wait five seconds without providing any other cues. If she complies, praise her specifically for her actions. If she does not comply, move to the next step: a verbal prompt with physical prompt follow-through.
Physical prompt:
Take your child hand-over-hand through the entire response as you say, "you need to (repeat instruction)."No praise is issued if you must utilize this step.

Important Pointers:

Behavior Management Strategies

Understanding what motivates your child's behavior and deciding how to approach it can be a daunting task. Although a formal, functional assessment is the most thorough method, there are some general and effective strategies to consider as a starting point. It is important to individualize them for your child. Some of these techniques, such as positive reinforcement and planned ignoring, are straightforward and intuitive in theory, but will prove to be quite difficult to implement. Therefore, remember to set reasonable expectations for yourself and your child and seek the support of a trained professional.

Differential Responding

Children typically enjoy receiving attention. If they do not receive enough positive attention for their good behaviors, they will often resort to behavior that results in negative forms of attention (e.g., yelling, nagging, "time out"). They would prefer to receive this negative attention than to do without attention all together. Over time, they learn which actions are the most effective in getting a response—positive or negative. This is called differential responding.

It is important to show your child more attention for acting appropriately than for acting inappropriately. This will motivate her to continue with positive behaviors. When used along with procedures to reduce inappropriate behaviors, such as ignoring (see below), it will encourage her to discriminate which behaviors will gain approval. It is important for children to learn that only appropriate behavior receives a response.

This makes sense to most people. When your child engages in appropriate behavior, she should receive a positive and heightened response; when she misbehaves, attention should be limited. Unfortunately, it is natural to respond oppositely to what is effective and aggravate the situation. That is, when your child acts appropriately, you (the parent or teacher) tend to ignore her good behavior fearing that if you respond it will "rock the boat." Conversely when she behaves negatively you respond dramatically. In reality, the best way to teach your child how to act appropriately is to attend to the positive behaviors and ignore the inappropriate behaviors. Particularly for children with DS-ASD, the easier it is to discriminate between responses to positive and negative behaviors, the quicker she will learn that the best (and only) way to get any form of attention is through good behavior.

Differential responding is most effective when both positive attention and ignoring are implemented. In this way, your child learns inappropriate behaviors result in no attention and acceptable behaviors result in positive attention. This eliminates at least one motivation for inappropriate behaviors such as attention seeking.

The components of these strategies, positive attention and ignoring, are detailed below.

Giving Positive Attention Effectively:

Using Planned Ignoring

Ignoring is a very active strategy that requires that you withhold eye contact and make no verbal response to the child. However, it does not mean to stand back and allow destructive or other behavior to occur. It is important at times to prevent and block behaviors as well as removing or diverting a child from an area or situation. It is important to keep everyone and everything safe.


Children with Down syndrome and autistic spectrum present a unique blend of characteristics. The dual diagnosis also complicates intervention strategies, particularly from a behavioral standpoint. Parents and professionals are often unsure what to do for behavioral issues when the dual diagnosis is present.

A practical approach is to use teaching strategies and behavior management methods that address the specific needs of your child and your family. Although this is best done with the assistance of a behavior specialist, some of the strategies described in this article are effective in helping you begin to make progress with your child.

Once you understand the main areas of need for your child and your family and the individual motivations for behavior, treatment of behavioral issues your child with Down syndrome and autistic spectrum is less mystifying. The core to effective teaching and appropriate behavior is consistency, consistency, and consistency!

Naomi Swiezy, Ph.D., is a Clinical Assistant Professor of Psychology in Psychiatry in the Autism Clinic at the Riley Hospital for children at Indiana University Medical Center. Prior to this she was the director of the Autism and Pervasive Developmental Clinic and behavioral consultant to the Down Syndrome Clinic at Kennedy Krieger Institute.